Provider Demographics
NPI:1629240304
Name:CRABTREE, KEVIN (MSPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 PRINCE ROYAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1471
Mailing Address - Country:US
Mailing Address - Phone:859-986-0375
Mailing Address - Fax:859-986-0305
Practice Address - Street 1:245 PRINCE ROYAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1471
Practice Address - Country:US
Practice Address - Phone:859-986-0375
Practice Address - Fax:859-986-0305
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1103363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00991002Medicare PIN